Newsletter January 2014 - DJO Globalstorage.djoglobal.eu/en_US/Documents/Support... · Only 15 have clinical evidence to support their effectiveness “Osteoarthritic Knee Braces

Research & Clinical Newsletter

January 2014

Bracing & Supports

Research & Clinical

In this newsletter (click on link):

A60 ANKLE BRACE is MORE EFFECTIVE THAN NEUROMUSCULAR TRAINING for REDUCING ANKLE SPRAIN RECURRENCE

SUCCESSFUL REHAB from HIP ARTHROSCOPY with X-ACT ROM BRACE

REVIEW RECOMMENDS ACL BRACING

REVIEW CONFIRMS EFFECTIVENESS of DONJOY OA BRACES is EVIDENCE BASED

SIMILAR DEGREE of PAIN RELIEF with VALGUS BRACE as with HIGH TIBIAL OSTEOTOMY

REVIEW CONFIRMS BRACING is RECOMMENDED CONSERVATIVE TREATMENT MODALITY for KNEE OA

LUMBAR CORSTETS may PREVENT THE DEVELOPMENT OF LBP IN GOLFERS

NEW RESEARCH PROJECT – CONSERVATIVE TREATMENT OF ACHILLES TENDON RUPTURE

Research & Clinical

A60 ANKLE BRACE is MORE EFFECTIVE THAN NEUROMUSCULAR TRAINING for REDUCING ANKLE SPRAIN RECURRENCE

47% less recurrent sprains

“Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial.” Janssen et al.

Br J Sports Med. 2014 Jan 7. [Epub ahead of print]

Purpose: To evaluate the effectiveness of combined bracing and neuromuscular training, or bracing alone, against the use of neuromuscular training on recurrences of ankle sprain after usual care.

Design: Randomised Controlled Trial

Subjects: 384 athletes who had sustained a lateral ankle sprain.

Methods: participants were randomly assigned to one of the three intervention groups:

training group: 8-wk home-based neuromuscular training programme,

brace group: Aircast A60 brace to be worn during all sports activities for 12 months,

combi group: training programme + brace for 8 weeks.

Outcomes:

Main outcome: self-reported recurrence of the ankle sprain.

Results:

47% reduction in risk of ankle sprain recurrence with A60 bracing versus neuromuscular training.

Conclusion: Bracing was superior to neuromuscular training in reducing the incidence (but not the severity) of self-reported recurrent ankle sprains after usual care.

iDJO link: http://intranet.djo.eu/en_US/variant-71426.html

SUCCESSFUL REHAB from HIP ARTHROSCOPY with X-ACT ROM BRACE

“Outcomes of endoscopic gluteus medius repair with minimum 2-year follow-up.” Domb et al. Am J Sports Med. 2013 May;41(5):988-97.


“Arthroscopic ligamentum teres reconstruction.” Lindner et al.

Arthrosc Tech. 2012 Dec 20;2(1):e21-5.


The X-Act ROM was part of a successful protocol in both studies for treating tears of ligaments / muscles around the hip joint endoscopically.

http://intranet.djo.eu/en_US/variant-71426.html



Research & Clinical

REVIEW RECOMMENDS ACL BRACING

controls anteroposterior laxity in ACL deficient patients

protects ACL after reconstruction

“Anterior cruciate ligament bracing: evidence in providing stability and preventing injury or graft re-rupture.”Bodendorfer et al.

Phys Sportsmed. 2013 Sep;41(3):92-102.

Purpose:

To review the available literature on the efficacy of knee brace use in the prevention and

treatment of patients with ACL injuries.

To identify populations that may benefit most from bracing.

Design: Review article

Results: bracing offers:

Prevention of anterior tibia translation mechanically by the brace but also through

improved muscle balance.

20-30% greater resistance to lateral blows to the knee.

Protection of failed ACL surgery but also of a successful reconstruction for highly active

athletes participating in high-impact sports.

Conclusion: Functional braces are recommended for ACL deficient patients and ACL reconstructed high-impact sports athletes.


EFFECTIVENESS of DONJOY OA BRACES is EVIDENCE BASED

42 OA braces identified on the US market

Only 15 have clinical evidence to support their effectiveness

“Osteoarthritic Knee Braces on the Market: A Literature Review.” Brooks.

J Prosthet Orthot. Jan 2014;26(1)2-30.

Purpose: to review the range of braces available on the US market and the clinical data supporting their efficacy in relieving symptoms and to provide an updated picture of each evidence based brace.


Results & conclusions:

42 custom and off-the-shelf OA knee braces are currently available within the US, yet only 15 have evidence-based information to support their effectiveness.

DonJoy OA Adjuster, Nano and Defiance are on the short list of evidence based braces.


Research & Clinical

The clinical data of these braces support their effectiveness in reducing pain, improving function and also in delaying surgery, and clearly suggest that they do reduce excessive compressive and shearing loads that are responsible for pain in symptomatic OA.

This article offers an outstanding competitive summary of the OA Market. It maps out where we stand vs. the competition from a research standpoint.


SIMILAR DEGREE of PAIN RELIEF with VALGUS BRACE as with HIGH TIBIAL OSTEOTOMY

When a valgus brace provides pain relief, then high tibial osteotomy (HTO) will provide similar degree of pain relief.

A valgus brace can be used as predictive tool for selecting HTO candidates.

“Valgus bracing in symptomatic varus malalignment for testing the expectable "unloading effect" following valgus high tibial osteotomy.” Minzlaff et al.

Knee Surg Sports Traumatol Arthrosc. 2014 Jan 17. [Epub ahead of print]

Purpose: to evaluate whether the expectable postoperative pain relief following valgus high tibial osteotomy (HTO) is reliably predictable with the temporary use of an unloading knee brace preoperatively.

Design: Prospective clinical trial.

Subjects: 57 patients with symptomatic varus malalignment.

Methods:

6-8 wks valgus brace treatment

Positive Brace test = pain relief medially without initiated symptoms laterally.

In "positive" Brace-Test cases -> a valgus HTO was suggested as a promising surgical option.

Follow-up evaluation 1 yr postop.

Outcome: Pain VAS (10 points scale)

Results:

48 patients had positive brace test (mean VAS decrease 6.7 to 2.5 points)

29 underwent HTO

Same level of pain relief post- HTO as with 6-8 wk bracing

Conclusion:

Significant pain relief with 6-8 weeks use of a valgus brace is correlated to comparable pain relief after HTO surgery and can therefore be used as a test tool for predicting the effect on pain relief from HTO.

Unloading of the medial compartment leads to significant pain reduction in the affected compartment and can be achieved either non-invasively by using a malalignment adjusting brace or invasively by valgus HTO with no significant difference between these two treatment alternatives.




Research & Clinical

BRACING is RECOMMENDED CONSERVATIVE TREATMENT MODALITY for KNEE OA

Helpful to promote a physically active lifestyle and offload the affected joint.

“Nonoperative treatment of unicompartmental arthritis: from bracing to injection.” Bert et al.

Clin Sports Med. 2014 Jan;33(1):1-10.

Purpose: To review the use of conservative treatment of OA of the knee.


Conclusion:

Conservative modalities of treatment of OA of the knee should be considered before consideration of more aggressive surgical approaches.

It is not uncommon to delay surgical intervention by several years by using a home program of weight loss, exercise, pharmacologic treatment, bracing, and injection therapy.


LUMBAR CORSTETS may PREVENT THE DEVELOPMENT OF LBP IN GOLFERS

Reduced lumbar rotations

Reduced lumbar hyperextension

“Lumbar corsets can decrease lumbar motion in golf swing.” Hashimoto et al.

J Sports Sci Med. 2013 Mar 1;12(1):80-7.

Purpose: To evaluate the effects of wearing lumbar corsets on the 3-dimensional motion of the trunk in amateur golfers.

Design: biomechanical study.

Subjects: 11 amateur golf players with no history of low back pain.

Methods: full golf swings were monitored with motion camera in three conditions:

without a corset

with a soft corset

with a hard corset

Outcomes:

Max ROM and angular velocity of lumbar rotation, flexion-extension, and lateral tilt

Rotation of the hip joint

Results & Conclusions:

Wearing lumbar corsets during a golf swing can effectively decrease lumbar extension and rotation angles and angular velocity.

The hard corset was most effective

Wearing lumbar corsets increased the rotational motion of the hip joint (compensatory) while reducing the rotation of the lumbar spine.




Research & Clinical

NEW RESEARCH PROJECT – CONSERVATIVE TREATMENT OF ACHILLES TENDON RUPTURE

Where: Denmark, Hidovre hospital in Copenhagen

Who: Dr. Kristoffer Barfod, PhD

2013: K. Barfod finished his PhD research on “Acute Achilles Tendon Rupture – Assessment of non-operative treatment”

Purpose of the thesis was to evaluate non-operative treatment of acute Achilles Tendon Rupture.

Background:

o Over the past decade a change in treatment of acute AT rupture away from operative towards non-operative treatment has taken place.

o However, the optimal non-operative treatment protocol remains to be clarified, particularly the role of early weight bearing during rehabilitation.

o There is a need for a clinically applicable and accurate measurement to detect patients in risk of developing AT elongation

Conclusions of his PhD thesis:

There is considerable variation in treatment algorithms across Scandinavia.

Operative treatment with early weight bearing is preferred treatment method.

In non-operative treatment, immediate weight bearing was found to be safe and recommendable (RCT – 60 patients - DJ Nextep Contour walker).

The novel ultrasound measurement by K. Barfod showed excellent reliability and acceptable validity.

2014: Continuation of AT research with support of DJO

Purpose: move more patients from operative to non-operative functional treatment by

Acquiring further insight into the optimal non-operative treatment protocol and the role early dynamic mobilisation in this protocol.

Validating reliable ultrasound measurement techniques allowing for distinguishing patients in need for an operation from those that don’t need an operation, based on the AT length in the acute phase.

Design:

Randomised controlled trial involving 130 patients.

All patients will use the AIRSELECT STANDARD for 6 weeks.